Percutaneous Fetoscopic Patch Coverage of Spina Bifida Aperta in the Human – Early Clinical Experience and Potential
- 1 February 2006
- journal article
- case report
- Published by S. Karger AG in Fetal Diagnosis and Therapy
- Vol. 21 (2), 185-193
- https://doi.org/10.1159/000089301
Abstract
The current operative approach for fetal repair of spina bifida aperta requires maternal laparotomy and hysterotomy. Following technical feasibility studies in sheep, we performed percutaneous fetoscopic patch coverage of this lesion in 3 human fetuses between 23 + 4 and 25 + 3 weeks of gestation.Whereas the patch detached in the first case 3 weeks after the procedure, it covered the exposed neural tissue in the 2 other fetuses beyond their delivery. Two of the three children survived, but 1 unexpectedly died from a ventilation problem in its 3rd week of life. In 1 of the 2 survivors, ventriculoperitoneal shunt insertion was delayed.Percutaneous fetoscopic patch coverage of spina bifida aperta is feasible in human fetuses and offers a substantial reduction of maternal trauma compared to open fetal repair. Further clinical experience is now required before the efficacy of the new approach to protect the exposed neural tissue from mechanical and chemical damage and to improve hindbrain herniation can be evaluated.Keywords
This publication has 21 references indexed in Scilit:
- Amniotic air insufflation during minimally invasive fetoscopic fetal cardiac interventions is safe for the fetal brain in sheepThe Journal of Thoracic and Cardiovascular Surgery, 2004
- Intrauterine repair of spina bifida: preoperative predictors of shunt-dependent hydrocephalusAmerican Journal of Obstetrics and Gynecology, 2004
- Percutaneous fetoscopic patch coverage of experimental lumbosacral full-thickness skin lesions in sheepSurgical Endoscopy, 2003
- Outcome in people with open spina bifida at age 35: prospective community based cohort studyBMJ, 2003
- The Rationale for in utero Repair of MyelomeningoceleFetal Diagnosis and Therapy, 2001
- Link between the CSF shunt and achievement in adults with spina bifidaJournal of Neurology, Neurosurgery & Psychiatry, 1999
- Percutaneous fetal access and uterine closure for fetoscopic surgerySurgical Endoscopy, 1997
- Endoscopic coverage of fetal open myelomeningocele in uteroAmerican Journal of Obstetrics and Gynecology, 1997
- Spinal Lesion Level, Shunt Status, Family Relationships, and Psychosocial Adjustment in Children and Adolescents with Spina Bifida MyelomeningoceleJournal of Pediatric Psychology, 1995
- The Cause of Chiari II Malformation: A Unified TheoryPediatric Neurosurgery, 1989